Dysraphic problems in the lumbar spine: dilemmas in management--a review of 49 cases.

Occult spinal dysraphism can present in many ways. In this review the clinical features, pathology, and management of 49 adult and pediatric cases are discussed. Most recent papers agree that surgery should be performed for clinical deterioration, and many now advise prophylactic surgery for stable or asymptomatic patients. This paper questions the role of prophylactic surgery in such patients. The natural history of occult dysraphism is not known, particularly in the case of adult or asymptomatic patients A conservative management policy, with operation reserved for subsequent clinical or electrophysiological deterioration, is still acceptable in stable or asymptomatic patients. The prospective study of cohorts of patients, with the various forms of occult spinal dysraphism, from units with differing management policies, will help to clarify the natural history of this condition and whether this may be influenced by prophylactic surgery.